Climate Change and Local Public Health in the United States: Preparedness, Programs and Perceptions of Local Public Health Department Directors

Abstract

While climate change is inherently a global problem, its public health impacts will be experienced most acutely at the local and regional level, with some jurisdictions likely to be more burdened than others. The public health infrastructure in the U.S. is organized largely as an interlocking set of public agencies at the federal, state and local level, with lead responsibility for each city or county often residing at the local level. To understand how directors of local public health departments view and are responding to climate change as a public health issue, we conducted a telephone survey with 133 randomly selected local health department directors, representing a 61% response rate. A majority of respondents perceived climate change to be a problem in their jurisdiction, a problem they viewed as likely to become more common or severe over the next 20 years. Only a small minority of respondents, however, had yet made climate change adaptation or prevention a top priority for their health department. This discrepancy between problem recognition and programmatic responses may be due, in part, to several factors: most respondents felt personnel in their health department–and other key stakeholders in their community–had a lack of knowledge about climate change; relatively few respondents felt their own health department, their state health department, or the Centers for Disease Control and Prevention had the necessary expertise to help them create an effective mitigation or adaptation plan for their jurisdiction; and most respondents felt that their health department needed additional funding, staff and staff training to respond effectively to climate change. These data make clear that climate change adaptation and prevention are not currently major activities at most health departments, and that most, if not all, local health departments will require assistance in making this transition. We conclude by making the case that, through their words and actions, local health departments and their staff can and should play a role in alerting members of their community about the prospect of public health impacts from climate change in their jurisdiction.

California’s local health agencies and the state’s climate adaptation strategy

“…The results of this survey are not unique to California. The general findings are similar to those developed from a survey of a sample of local health officers nationwide (Maibach et al 2008). Local health officers recognize the risks associated with climate change, but generally feel that they lack the resources and expertise to address the risk.…”

Temperature and mortality on the roof of the world: A time-series analysis in three Tibetan counties, China

“…It appears to be the case that health implications of climate receive less attention, not only in Tibet but also in some industrialized countries (Maibach et al, 2008), compared with the energy, economic and agriculture implications. Preparation of adaptation strategies in Tibet will face the lack of reliable long-term health data, lack of awareness among both the public and health professionals of the magnitude of health threats due to extreme weather and harsh geographic conditions.…”

Preparedness for Climate Change Among Local Health Department Officials in New York State

“…The survey instrument has previously been described in detail. 13,14 While the method of administration differed between the national sample and this state-based survey, the questions and response choices were unchanged.…”

“…13 Given that LHD staff size is proportional to jurisdiction population, we can make certain inferences about jurisdiction sizes represented in our survey and comparability with national survey sample. Within the “Are We Ready” sampling design criteria, six New York State LHDs (including Suffolk and NYC) would have been characterized as representing “large” jurisdictions 18 , indicating that even if our sample captured the other four “large” LHDs, it would still be relatively skewed toward “small” and “medium” jurisdictions.…”

“…One exception is the 2007 “Are We Ready” survey of members of the National Association of County and City Health Officials (NACCHO) conducted by George Mason University's Center for Climate Change Communication and the Environmental Defense Fund. 13,14 The results of that national sample demonstrated widespread perception of climate change as a current and future threat to public health, but one for which most local public health departments (LHDs) did not yet have a specific adaptation or prevention programs. These survey results echo findings of insufficient funding for and prioritization of climate change on the national policy-making agenda.…”